How would you answer that seemingly simple question? Could you answer that question? Not many of us understand how neuroscience and the brain guide us in self-identification. Research in and understanding of the differences in gender development, identity and expression have come a long way in recent years, but we still have a lot to learn. No one understands the need for more research better than Erica E. Anderson, Ph.D., a professor, a clinical psychologist and a transgender woman.

What is neuroscience’s role in understanding gender?

We are learning more and more about how the brain works and the impact of brain function upon all human traits and behavior. It appears that the brain and consciousness have more to do with the development of gender identity than the body’s development. Likewise, socialization of transgender persons—when it has been to reinforce viewing gender in a binary construction that is in line with assigned/designated sex at birth—seems in some cases to aggravate what we have historically called gender identity disorder, now known as gender dysphoria.

The neuroscience relevant to gender identity is not yet well developed but suggests that there is interplay among genetics or epigenetics; prenatal chemical factors (such as hormones and their effects upon brain development in utero); and other environmental, biological and psychological factors and all aspects of human development, including gender. Until recent years, few thought of gender as subject to development.

Why is the neurological basis of gender and identity development such an important topic?

Some individuals do not fit the dominant binary gender schema. The development of gender identity—related to but different from gender expression—is interwoven with, but not the same as, sexual development. Identity development was thought to proceed in a linear and rather predictable way. Within a heteronormative model this might be true, but not so for sexual minorities such as LGBTQ and others whose sexual and gender identities constitute variations.

In the recent past, these variations were regarded as aberrant and classified as disorders in psychiatric nomenclature. Only very recently have we come to regard “alternate” (to heterosexual) sexualities and nonbinary gender identities as normal variations. And we are witnessing the fluidity of these variations in a surprising way. Sexual identity, sexual orientation, gender identity and gender expression are all fluid.

The first Diagnostic and Statistical Manual of Mental Disorders (DSM) identified homosexuality as a sexual “aberration.” Today, the evidence is clear that the previous thinking was wrong and there is no necessary relationship between being gay and having psychiatric problems. We are coming to learn the same thing about gender identity and expression. In the meantime, because of the mistreatment of sexual minorities—in particular transgender and gender-nonconforming (GNC) persons—many trans and GNC persons suffer from social and psychological problems at a much higher incidence than the general population. Now we believe it is likely caused by co-occurring issues of marginalization and shame. A global discussion within mental health professional circles is finally occurring; DSM V has replaced gender-identity disorder with gender dysphoria, and in the upcoming International Classification of Diseases (ICD) XI, gender dysphoria is slated to be placed outside of psychiatric disorders and into the category of developmental “differences.” In other words, normal variations. To me, this constitutes the most dramatic turn possible in the life of a once-closeted transgender psychologist who was—for decades—afraid of losing her license to practice clinical psychology because she had a “deep-seated psychiatric disorder.”

In addition to being a professor, Dr. Erica Anderson has her own practice, providing a community resource to those who are at a gender-identity crossroads.

How have your life experiences affected how you teach?

I have the experiential knowledge of a transgender person, and I have training as a scientist and clinical psychologist. I am mindful that my own experience is just that. I like to say, “When you have seen one transgender person, you have seen one ... transgender ... person.” And in my case, I have seen and personally experienced a breathtaking shift in cultural attitudes about transgender persons and had a parallel evolution occur early in my career as a transsexual psychologist. I seek to educate, whether in classes or lectures or in my informal and personal interactions with others, and I have experienced a full range of reactions. However, I am gratified whenever hearts and minds are changed.

According to an article on NationalGeographic.com, 1,000 millennials ages 18 to 34 responded in a recent survey that “gender is a spectrum, and some people fall outside conventional categories.” What is the impact of defining gender as a spectrum?

I have been teaching this topic for years. What is more obvious to see is that gender expression is a spectrum; less obvious is that gender identity is also a spectrum. The millennials form a large group of people who are refusing to choose a gender. They may say that they are gender-queer or gender-nonconforming, and they illustrate this in increasingly obvious, and in some cases, militant ways.

It is my belief that masculine and feminine are not opposite poles on one continuum. I teach that they are likely two continua, and there is no necessary interrelationship between them nor is any one individual fixed at points along them. Gender identity, gender expression, and even sexual orientation and sexual identity are fluid. I want to convey this in my Gender Development: Neuroscience, Transgender and Individual Differences course and help challenge preconceived notions about these matters.

How do you see gender data collection and reporting changing?

Huge challenges lie ahead in society if we embrace transgender identities. Most survey and enrollment forms, health systems, government programs, et cetera, only accommodate binary gender identities. There is also little uniformity among transgender persons about how to describe themselves. In my case, I always check the box “female.” Yet, the health care system insists that I have an ongoing diagnosis of gender dysphoria. I no longer suffer from gender dysphoria—I am happy and well-adjusted as a female—and I no longer receive nor need treatment for conflicts about my gender.

But my health care system insists that the diagnosis continue in my health record. In addition, because all of this monumental data is coded in the binary male/female way, we will have difficulty mining data in large databases such as Medicare or Social Security.

The gender-queer or gender-nonconforming population also presents a new set of health care challenges. Right now, our society is ill-prepared to fully engage in the challenges that language and data and the relationship between them presents.

From a health care perspective, how important is it for society to recognize and understand the issues that affect transgender individuals, especially in this political climate?

Society is still organized around the dominant gender schema, which allows no room for discussion of transgender or gender-nonconforming persons or issues. Ignorance is more often the rule rather than the exception; education for everyone continues to be critical. Because the health care system is set to treat males or females, transgender persons too frequently have to work harder and smarter to obtain the medical care they need.

From a mental health perspective, too few clinicians have been trained in handling transgender issues. This has led to too many transgender people being treated by professionals who have not yet developed competence in transgender health care. Or they are being treated by professionals operating under stereotypes, old information or out-of-date standards of practice. I am trying to help close that gap in education.

The emergence of transgender issues is seen as transgressive by many in the nation. Some with very conservative social or religious views object to affording transgender persons their full civil rights. Transsexual issues entail the whole person and the person’s participation in society, making it more complicated than sexual orientation or racial discrimination. Gender identity has not yet become consistently protected against discrimination. Reactionary and ignorant persons utilize the “bathroom bills” to control the “threat to civilized society” they believe trans persons to be. So while many recent LGBTQ gains push general society toward full acceptance, many in the trans community fear those gains will be reversed with the new administration in Washington, D.C. Hence, all the more need to educate and train health professionals to become competent in understanding gender development from a neuroscience perspective and promote moving forward.

Erica E. Anderson, Ph.D., is a professor of clinical psychology at John F. Kennedy University and associate professor of pediatrics at University of California, San Francisco. Her experience has been covered in Svensk Psykiatri, the journal of the Swedish Psychiatric Association, and she was a finalist for Transgender Person of the Year in Sweden, as a result of her TV show, Allt för Sverige. Anderson offers both professional and experiential perspectives in her clinical psychology practice.